Anterior cruciate ligament (ACL) tears are among the most common sports injuries. This type of injury occurs much more frequently in women than in men; the National Institute of Health states that women are 2-8 times more likely to tear this ligament depending on activity.
ACL tears are best avoided; ligaments heal slowly, and this type of injury may require surgery. Fortunately, there are training steps you can take to help prevent harm to your knee.
The ACL is one of four ligaments that connects the thigh bone to the shin bone. It stretches from the front of the tibia to the back of the femur. The ligament’s main functions are to assist in stabilizing the knee and prevent hyperextension of the joint.
Women are more likely to suffer from a torn ACL for several reasons. One is wider hips, which cause the knees to be positioned slightly inward. Women also have more laxity of the ligaments, likely do to hormonal factors. This puts the ligament at risk of being overstretched. Another risk for women is that the ligament itself and the bone notch through which it passes are smaller than in men. This leads to less sturdiness of the structure and more tension placed on it by the restrictive notch.
ACL tears occur when the femur and tibia are rotating in opposite directions. This situation is most common when an athlete lands hard, side-steps or pivots. Muscle imbalances and a weak core contribute to the likelihood of knee injury.
One of the most important muscles to consider in relation to knee angle is the gluteus medius. This muscle on the outside of the buttocks is an important part of the core group. It serves both as a hip abductor (moves the hip outward) and a stabilizer. Stabilizer muscles help keep the body aligned and steady. A strong gluteus medius will help to prevent the thigh from tilting or rotating inward upon fast movements.
Many people are quad-dominant, meaning the muscles of the front of the thigh are stronger than the hamstrings and glutes in back. Strong, tight quads can pull up the knee, causing the leg to be straighter upon landing. This rigidity increases the risk of knee injury as the forces sustained by the knee are greater when it’s extended.
Holly Silvers, MPT (Master of Physical Therapy), has designed and implemented a training regimen to prevent the incidence of ACL injuries among athletes, specifically females. Her Prevent Injury and Enhance Performance (PEP) plan helped to reduce injury rates among 2,100 female soccer players by 88% in one study.
PEP employs a number of principles to form an effective warm-up: strength, flexibility, agility and muscle coordination. Strong muscles in the leg and core will help support the alignment of the pelvic and knee joints. Flexibility of the muscles is needed to prevent pulling on the knee. Agility training helps the athlete make fast movements with proper form and bio-mechanical efficiency. Muscle coordination – the properly-timed joint firing of muscles to action – is an important part of injury prevention. The quads and hamstrings, for example, should be engaged to support the knee when a person lands from jumping. Polymetric jumping exercises can help facilitate muscle coordination and balance.
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